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HCPCS J1938 · Level II · Part B drug

HCPCS J1938: Injection, furosemide, 1 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J1938

Billing unit
1 MG
Inj, furosemide, 1 mg
ASP payment limit
$0.018
October 2026; +0.0% vs July 2026
Practitioner MUE
5360
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J1938 is the Level II code for Injection, furosemide, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.018 per billing unit, up 0.0% from July 2026. The practitioner MUE allows up to 5360 units per date of service (MAI 3). Under OPPS it carries status indicator N. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 57 NDCs to it, sold as Furosemide by Hikma Pharmaceuticals USA Inc., Henry Schein Inc., Pfizer Inc. No current Billing and Coding Article lists J1938, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J1938 at $0.018 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.018 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1938
QuarterPayment limitPerCoinsurance
October 2026$0.0181 MG20%
July 2026$0.0181 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 57 NDCs from 17 labelers to J1938. Report the NDC in the claim's drug segment and bill the number of J1938 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J1938
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9155-25FurosemideHikma Pharmaceuticals USA Inc.2 × 25500
00143-9156-10FurosemideHikma Pharmaceuticals USA Inc.4 × 10400
00143-9157-10FurosemideHikma Pharmaceuticals USA Inc.10 × 101000
00143-9158-01FurosemideHikma Pharmaceuticals USA Inc.50 × 1500
00143-9159-01FurosemideHikma Pharmaceuticals USA Inc.100 × 11000
00404-9861-10FurosemideHenry Schein Inc.10 × 1100
00404-9862-10FurosemideHenry Schein Inc.10 × 1100
00404-9863-04FurosemideHenry Schein Inc.4 × 140
00404-9864-02FurosemideHenry Schein Inc.2 × 120
00409-6102-02FurosemidePfizer Inc2 × 25500
00409-6102-04FurosemidePfizer Inc4 × 251000
00409-6102-10FurosemidePfizer Inc10 × 252500
16729-0500-08FurosemideAccord Healthcare Inc2 × 25500
16729-0501-43FurosemideAccord Healthcare Inc4 × 10400
16729-0502-43FurosemideAccord Healthcare Inc10 × 101000
23155-0473-41FurosemideHeritage Pharmaceuticals Inc.2 × 25500
23155-0473-42FurosemideHeritage Pharmaceuticals Inc.4 × 251000
23155-0473-44FurosemideHeritage Pharmaceuticals Inc.10 × 252500
25021-0311-02FurosemideSagent Pharmaceuticals2 × 25500
25021-0311-04FurosemideSagent Pharmaceuticals4 × 251000
25021-0311-10FurosemideSagent Pharmaceuticals10 × 252500
25021-0320-02FurosemideSagent Pharmaceuticals2 × 25500
25021-0320-04FurosemideSagent Pharmaceuticals4 × 251000
25021-0320-10FurosemideSagent Pharmaceuticals10 × 252500
36000-0282-25FurosemideBaxter Healthcare Corporation2 × 25500
36000-0283-25FurosemideBaxter Healthcare Corporation4 × 251000
36000-0284-25FurosemideBaxter Healthcare Corporation10 × 252500
51662-1226-03FurosemideHF Acquisition Co. LLC, DBA HealthFirst10 × 252500
51662-1227-01FurosemideHF Acquisition Co. LLC, DBA HealthFirst2 × 120
51662-1572-01FurosemideHF Acquisition Co. LLC, DBA HealthFirst2 × 120
51662-1572-03FurosemideHF Acquisition Co. LLC, DBA HealthFirst2 × 25500
51662-1574-01FurosemideHF Acquisition Co. LLC, DBA HealthFirst4 × 140
51662-1574-03FurosemideHF Acquisition Co. LLC, DBA HealthFirst4 × 251000
51662-1575-01FurosemideHF Acquisition Co. LLC, DBA HealthFirst10 × 1100
55150-0322-25FurosemideEugia US LLC2 × 25500
55150-0323-25FurosemideEugia US LLC4 × 251000
55150-0324-25FurosemideEugia US LLC10 × 252500
63323-0280-02FurosemideFreseniUS Kabi USA, LLC2 × 25500
63323-0280-04FurosemideFreseniUS Kabi USA, LLC4 × 251000
63323-0280-10FurosemideFreseniUS Kabi USA, LLC10 × 252500
63323-0280-16FurosemideFreseniUS Kabi USA, LLC2 × 25500
63323-0280-26FurosemideFreseniUS Kabi USA, LLC4 × 251000
63323-0280-36FurosemideFreseniUS Kabi USA, LLC10 × 252500
70121-1076-05FurosemideAmneal Pharmaceuticals, LLC10 × 252500
70860-0302-02FurosemideAthenex Pharmaceutical Division, LLC2 × 25500
70860-0302-10FurosemideAthenex Pharmaceutical Division, LLC10 × 252500
71288-0203-03FurosemideMeitheal Pharmaceuticals Inc.2 × 25500
71288-0203-05FurosemideMeitheal Pharmaceuticals Inc.4 × 251000
71288-0203-11FurosemideMeitheal Pharmaceuticals Inc.10 × 252500
72572-0190-25FurosemideCivica, Inc.4 × 251000
72603-0133-25FurosemideNorthstar RxLLC2 × 25500
72603-0251-25FurosemideNorthstar RxLLC4 × 251000
72603-0474-25FurosemideNorthstar RxLLC10 × 252500
81565-0201-02FurosemidePhlow Corporation2 × 25500
83634-0302-02FurosemideAvenacy Inc.2 × 25500
83634-0302-04FurosemideAvenacy Inc.4 × 251000
83634-0302-10FurosemideAvenacy Inc.10 × 252500

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1938. For practitioners the limit is 5360 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J1938 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services53603 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital53603 Date of Service Edit: ClinicalPrescribing Information
DME supplier53603 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1938 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J1938 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J1938 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J1938 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J1938 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J1938 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J1938

What does HCPCS code J1938 describe?

J1938 is defined by CMS as "Injection, furosemide, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1938 in October 2026?

The ASP-based payment limit is $0.018 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.018.

How many units of J1938 can be billed per day?

The practitioner Medically Unlikely Edit is 5360 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Which NDCs map to J1938?

The October 2026 ASP crosswalk lists 57 NDCs from 17 labelers: Furosemide (Hikma Pharmaceuticals USA Inc.); Furosemide (Henry Schein Inc.); Furosemide (Pfizer Inc); Furosemide (Accord Healthcare Inc). For example NDC 00143-9155-25 is a 2 package equal to 500 billing units. The crosswalk's billing-units-per-package figure converts each package into J1938 units.

Does J1938 have NCCI bundling edits?

No active practitioner PTP pairs list J1938 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.